The American Institute of Ultrasound in Medicine had their 2013 Annual Meeting in New York.  Several sessions were live tweeted by myself and others.  It was an interesting meeting for several reasons.  I was able to sit in on the Bioeffects committee meeting and participate in several interesting discussions.

A pre-convention session on education in ultrasound during medical schools was created and used to discuss the topic, @SonoMedEd.  This was coordinated in part by @EDUltrasound. Also during the meeting I had the chance to meet @MarcoAlvarez in real life.

There was a hands on workshop on Ultrasound Guided Vascular Access co-sponsored by the Emergency Medicine-Critical Care and Interventional Radiology Communities of Practice (AIUM’s version of interest groups/sections).  The short voiced over lecture will be voiced over and posted later.

Here is a transcript of the Twitter feed for #AIUM13 with some informational graphics from Symplur.

Here is a transcript of the

Was one of the faculty for a simulation day with some lecture stations.  The station I had was a short lecture on the setting up of emergent transcutaneous and transvenous pacing followed by some hands on.  Figured I would record the lecture and post it up for whoever was interested.  I did have to put in some echo guided pacemaker insertion clips since I was giving the presentation.

A side note some of the discussion points may not be applicable depending on what kind of equipment your facility regularly stocks.

I recently had the chance to attend the American Institute of Ultrasound in Medicine’s Ultrasound First Forum.  This was held on November 12, 2012 in New York.  In full disclosure I did attend as a representative of the AIUM as an invitee.

Members from different societies and groups attended this forum to discuss medical ultrasound and how it can be promoted as a first line diagnostic therapy when appropriate. The thought of ultrasound first is to use a dynamic imaging modality that has no ionizing radiation and can provide the diagnostic information in many cases.

The discussion focuses on using ultrasound rather CT scans or MRI in cases where appropriate.  Examples were given of female pelvis pain where ultrasound was more diagnostically appropriate and informative then CT scanning.  Musculoskeletal complaints that could be evaluated dynamically, more thoroughly, and with better resolution with ultrasound compared to the static MRI were also given.  These discussions all had merits and we heard from medical organizations, patient advocacy groups, and practitioners about why ultrasound should be considered before some other imaging modalities.

I agree that we should consider ultrasound before other imaging modalities such as CT and MRI when appropriate and available.  That is the key point that has to be kept in mind.  When ultrasound is an appropriate test it should be considered first.  It does not mean it always has to be the first test, but considered and if appropriate be the first test.

It also depends if you have the equipment and personnel to perform and interpret ultrasound in some of these situations.  We are leaders in our areas of medical expertise; but there is a variability in ability and resources across the country and the world.  Not every hospital in every corner of the world can provide ultrasound in all its myriad forms and applications.  In some areas ultrasound may not be the best first choice due to limitations in equipment, skill, personnel or other factors.

While I am an ultrasound evangelist and firmly believe in the technology and its role in patient care I also do recognize that there can be limitations in making ultrasound first even when appropriate, at least for today.

Here are links to the Ultrasound First site with the Sound Judgement series from JUM and AIUM.

Here is the collection of the tweets using the #US1st hashtag during the forum.

PS: As a side note ultrasound guidance for vascular access was also discussed at the forum. The AIUM Practice Guideline on US guidance for vascular access is forthcoming, I was able to see a draft at the forum.  If you have ultrasound and are performing an non-crash IJ there is no reason to not use ultrasound.

A recent article was published in the Journal of Ultrasound in Medicine regarding non-pathologic abdominal free fluid in males.  If you read only the abstract and don’t delve into the study the wrong conclusions can be drawn.

Short video reviewing the key points of the article and some example images to highlight key points.

Trying a little something different with the video posted on YouTube to see if this makes it easier for people to view the videos.  Let me know what you think in the comments.

The article is online at the Journal of Ultrasound in Medicine at http://www.jultrasoundmed.org/content/31/10/1527.abstract

This is a short video recording about the Ultrasound education research that I am presenting at the American College of Emergency Physicians 2012 Research Forum. Click on the image to play the video.

There was a recent letter published by Reusz G et al in the Canadian Journal of Anaesthesiology about the appearance of the needle tip during ultrasound guided vascular access.  I agree with some of their points; not earth shattering findings.  But I do think they missed an important point when it comes to peripheral vascular access.

This short video discusses the findings of the paper, my thoughts, and some examples. Click on the image to play.

There are several ways to differentiate pleural pericardial effusions. This video goes over one method using a parasteral long axis view. It highlights some anatomy that isn’t always mentioned when reviewing echocardiography texts.

Plus it allowed me to test drive a new program called Doodlecast Pro. Let me know what you think for this format.

This research letter is published online ahead of print in the American Journal of Emergency Medicine.  It reviews some of the Twitter statistics from the American College of Emergency Physicians 2010 Scientific Assembly and the Society for Academic Emergency Medicine 2011 Annual meeting.

It also raises the idea of the metric of individual user, original tweets, and original tweet per individual user for evaluating Twitter volume during conferences.

The citation and a pre-production pdf version for those who do not have journal access is: Nomura JT, Genes N, Bollinger HR, Bollinger M, Reed JF 3^rd. Twitter Use During Emergency Medicine Conferences. Am J Emerg Med. Epub ahead of print. PMID 22424992.

This is an expanded version of the table with data points that were not included in the letter due to some requested edits and length.

SAEM Social Media Committee Video Conference

Short video conference discussing the upcoming didactic session at the Society for Academic Emergency Medicine on Social Media and the Academic Physician at the 2012 Annual Meeting.

**This post was originally part of the ACEP Emergency Ultrasound Section’s Newletter in the Tips and Tricks section . The newsletter is located on the member only section of the site so I am posting here to make it more available.**

Patients commonly present with complaints of abdominal hernias and are frequent incidental findings in the emergency department. Incarcerated hernias can cause swelling, pain, and may require emergent surgical consultation if strangulated.

While an incarcerated hernia can be found on physical exam, ultrasound can assist in the management of these cases. Imaging the incarcerated hernia to identify the contents of hernia sac can help differentiate bowel from adipose tissue. As well, one can identify concomitant pathology such as free fluid, bowel wall thickening, pneumotosis coli, aperistalsis, and abnormal blood flow.

Diagnostic imaging is commonly described in many texts and articles; however, an additional step in the imaging protocol can help with the management of incarcerated hernias. Scan through the hernia sac and pay special attention to the abdominal wall for the break in the wall or the neck of hernia sac, this will allow planning for reduction. Identification of the neck allows the operator to direct the hernia contents toward the neck during manual reduction. It also allows the clinician to identify the size of the neck compared to the hernia contents.

Figure 1 shows an incarcerated ventral hernia containing small bowel. The neck can be identified by the defect in the abdominal wall. This hernia was successfully reduced by applying pressure from the lateral edge of the bowel loop toward the neck. Figure 2 shows the hernia post reduction containing only fat; the fascial defect is still visible.

While this large hernia had a midline neck, that is not always the case as demonstrated in Figure 3. The neck is visible and the hernia sac is laterally located. Evaluation of the hernia contents and neck location can aid in planning the reduction. Practice visualizing known hernias and the fascial defect or neck on patients with hernias that are not incarcerated or strangulated.

Figure 1: Incarcerated hernia with bowel and neck visualized.

Figure 2: Post reduction the fat containing hernia and neck are visualized.

Figure 3: Small hernia sac that is lateral to the neck.